Abstract

Background

The aim of this study was to describe the clinical features, haematological findings
and CD4+ and CD8+ cell counts of severely malnourished children in relation to human immunodeficiency
virus (HIV) infection.

Methods

The study was conducted in the paediatric wards of Mulago hospital, which is Uganda's
national referral and teaching hospital. We studied 315 severely malnourished children
(presence of oedema and/or weight-for-height: z-score < -3) and have presented our
findings. At admission, the CD4+ and CD8+ cells were measured by the flow cytometry and HIV serology was confirmed by Enzyme
linked Immunoassay for children >18 months of age, and RNA PCR was performed for those
≤18 months. Complete blood count, including differential counts, was determined using
a Beckman Coulter counter.

Results

Among the 315 children, 119 (38%) were female; the median age of these children was
17 months (Interquartile range 12–24 months), and no difference was observed in the
HIV status with regard to gender or age. The children showed a high prevalence of
infections: pneumonia (68%), diarrhoea (38%), urinary tract infection (26%) and bacteraemia
(18%), with no significant difference with regard to the HIV status (HIV-positive
versus HIV-negative children). However, the HIV-positive children were more likely
to have persistent diarrhoea than the HIV-uninfected severely malnourished children
(odds ratio (OR) 2.0, 95% confidence interval (CI) 1.2–3.6). When compared with the
HIV-negative children, the HIV-positive children showed a significantly lower median
white blood cell count (10700 versus 8700) and lymphocyte count (4033 versus 2687).
The CD4+ cell percentages were more likely to be lower in children with non-oedematous malnutrition
than in those with oedematous malnutrition even after controlling for the HIV infection.

The novel observation of this study is that the CD4+ percentages in both HIV-positive and HIV-negative children without oedema were lower
that those in children with oedema. These observations appear to imply that the development
of oedema requires a certain degree of immunocompetence, which is an interesting clue
to the pathophysiology of oedema in severe malnutrition.